Environment, climate change and heart health

Globally, air pollution causes around one in five deaths from cardiovascular disease. In Australia in 2018, air pollution caused over 3,200 deaths.

Air pollution refers to the small particles and gases that circulate in the air. When people inhale these particles and gases, they can harm the heart and lungs.

Air pollution can occur in both outdoor and indoor environments.

Long-term exposure to air pollution can increase the risk of cardiovascular disease. This includes heart attack, coronary heart disease, abnormal heart rhythms, cardiac arrest, heart failure and stroke.

People with existing heart conditions are most at risk of problems from air pollution.

Air pollution comes from many sources including:

• exhaust fumes from cars, trucks and other vehicles (particularly those with diesel engines)

• traffic-related pollution including tyre and brake wear

• bushfires or fires for cooking or warmth

• indoor woodfire heaters

• agricultural activities (farming) and waste burning

• outdoor power equipment and marine engines

• industrial activities like manufacturing and food production

• secondhand tobacco smoke

• dust, dampness and mould

• chemicals, cleaning products and indoor floor polishing equipment.  

We know that when people breathe in very small air pollution particles, this can affect the heart by:

• damaging blood vessels so they become hard and narrow

• increasing the risk of blood clots

• increasing blood pressure

• disrupting the electrical activity of the heart, which can lead to abnormal heart rhythms

• changing the structure of the heart (in a similar way to what happens in early heart failure).

Air pollution is a global issue, which needs the cooperation of communities, governments and organisations. The Heart Foundation has been a key advocate for healthy built environments via Healthy Active by Design and other programs to encourage active healthy lives for all.

There are some simple things you can do to help reduce air pollution and your exposure to it.

• Know the air quality in your area. You can look this up on an interactive map on the Bureau of Meteorology website. If you know when air pollution levels are high, you can take steps to limit your exposure.

• Where possible, walk or cycle in places where air pollution is lower. Or choose a time of day when air pollution levels are lower (for example, before or after peak hour).

• If you have a heart condition, it’s especially important to avoid spending a lot of time in places that have higher air pollution levels, such as busy roads or near factories.

• Walking or cycling (instead of driving) also helps to reduce air pollution.

• Avoid indoor fires for cooking and warmth. If this isn’t possible, portable air purifiers can help reduce indoor air pollution.

Protect your lung and heart health by stopping smoking. Did you know the best way to quit is with support from Quitline (13 7848) and medicines like nicotine replacement therapy? Also avoid being exposed to secondhand smoke from cigarettes and e-cigarettes/vapes.

A heatwave is an unusually high temperature that occurs at least three days in a row.

Over the past 20 years, there has been an increase in the frequency and intensity of heatwaves in Australia. Our heatwaves are also lasting longer. One of the main causes is climate change.

Heatwaves can be dangerous for people with existing health conditions, including heart conditions. People aged 65 years and older and people experiencing socioeconomic disadvantage are also at higher risk during a heatwave.

There are two main ways that heatwaves can affect your heart.

• On hot days, your blood is redirected closer to the skin’s surface to help maintain your normal temperature. This means your heart needs to work harder to pump blood around the body.

• You are also more likely to get dehydrated as your body sweats to keep you cool. This means your blood pressure can drop if you aren’t drinking enough water. When you’re dehydrated, your heart must work harder.

Here are our top tips for looking after yourself during a heatwave.  

Stay hydrated

• Drink plenty of water (or follow your doctor’s advice on how much you should drink each day if you have heart failure).

• Avoid alcohol and too much caffeine. These drinks can make you more dehydrated.  

Keep cool

• Stay indoors and use an electric fan if you have one.

• Did you know that electric fans use a lot less electricity than air conditioning? Use an electric fan for as long as possible before turning on your air conditioner (if you have one). This will help keep you cool while using less electricity and saving you money!

• You can also try one of these strategies:

  • Take a cool shower or bath, or sponge yourself with cool water to keep your skin wet.

  • Put crushed ice in a towel and place it around your neck or on your chest.

  • Keep your clothing wet by spraying yourself with cool water roughly every hour.

  • Put your feet or your hands and forearms in a bucket of cool water.

• When outdoors, stick to the shade as much as possible. Wear loose, light-coloured clothing.

• Reduce your level of physical activity when it’s hot. Take breaks often.

Look after yourself and others

• Plan ahead if you know a heatwave is coming. This might include doing your shopping ahead of time or making sure you have enough of your medicines. Being prepared means you can limit the amount of time you have to spend outside when it’s hot.

• If you take medicines for a heart condition, your doctor might need to adjust them. This includes some medicines for blood pressure. Some medicines can also increase the risk of dehydration. Speak to your doctor or pharmacist for more information.

• Keep your medicines stored in a cool, dry place below 25° C or in the fridge. Read the consumer medicines information leaflet for storage information or ask your pharmacist.

• Know the symptoms of heat-related illness. Symptoms include muscle pain or cramps, dizziness, strong thirst, headache, fainting, feeling tired or weak, nausea or vomiting and confusion. If you experience any of these symptoms, tell someone and speak to your doctor. If your symptoms are severe, call triple zero (000).

• Keep in contact with family and friends. Let them know if you’re OK or if you need help.

Check on people who are isolated or might need help, especially if they have a heart condition or other chronic condition like diabetes.

Bushfires are increasingly common in Australia. They are becoming more widespread and severe due to climate change. Bushfires most commonly affect regional and remote locations, and the effects can be devastating. Bushfire smoke can also travel over long distances, meaning even people living in cities can be exposed. Bushfires are a common source of air pollution.

Smoke exposure can put increased stress on the heart and can be dangerous for people with heart conditions (such as heart failure and high blood pressure) and people aged 65 years and over. The bushfires in Australia over the summer period in 2019-2020 coincided with an increase in people going to hospital for heart attacks.

Bushfire smoke can contain harmful gases (carbon monoxide) and toxins. Bushfire smoke also creates tiny solid particles and airborne liquid droplets that you can’t see. This is called ‘particulate matter (PM)’. These small particles can cross the lungs into the bloodstream.

Being exposed to bushfire smoke might also increase the risk of cardiac arrest or heart attacks.

Exposure to bushfire smoke can cause symptoms including:

• chest pain or tightness

• eye, nose and throat irritation

• difficulty breathing, shortness of breath, coughing or wheezing

• racing heart or palpitations  

• tiredness.  

If you experience any of these symptoms, tell someone and speak to your doctor. If your symptoms are severe, call triple zero (000).

It might not be possible to completely avoid smoke from a nearby bushfire. But here are some key things you can do to look after yourself.

• Plan ahead wherever possible. Make sure you have enough food, supplies and medicines to limit the amount of time you need to spend outside. Get in touch with friends or family as soon as possible if you need help. If you’re able to, help any family members, neighbours and friends if they are older, isolated or vulnerable. 

• Stay indoors where possible and if it’s safe to do so. Keep your windows and doors shut when there’s smoke outside. Open them when the smoke disappears.

• Limit outdoor physical activity (including walking) if you are in a smoke or fire-affected area, especially if the air quality is very poor or hazardous. Aim to exercise during parts of the day when air quality is better. Keep up to date with advice from your local government area on what to do. You can check air quality, here.

• If you have air conditioning, switch it to recycle or recirculate which will help filter air particles.

• Keep your medicine with you or close by and follow the advice of your doctor.

• If possible, find cleaner, filtered air-conditioned spaces (for example, shopping centres, libraries). Consider staying with family members or friends if they live outside the smoke-affected area.

• Stay hydrated by drinking plenty of water.

• N95 masks can provide protection against bushfire smoke and air pollution, but only if they are properly fitted. For more information, speak to your doctor or read more, here.  

The Heart Foundation is a long-term advocate for built environments that promote and support heart health, healthy eating, active living and physical activity.  

• Our Healthy Active by Design resources are dedicated to improving the health and liveability of buildings, streets, towns and cities. This includes creating environments to improve the safety and convenience of walking and cycling. This can improve air quality by reducing motor vehicle traffic. Creating more green spaces with trees can also help cut down air pollution levels. Read more, here.

• Our Blueprint for an Active Australia identifies evidence-based actions to improve physical activity in Australia. Action areas 1 and 4 discuss the importance of the built environment, and the need to encourage people to walk, cycle and use public transport for recreation and commuting (‘active travel’). Read more, here.

• Food sustainability is central to addressing climate change. There is growing evidence that dietary patterns consistent with heart-healthy eating align with current recommendations on sustainable eating practices. For example, opting for mostly plant-based foods and reducing intake of highly processed discretionary foods and drinks.

• Where possible, the Heart Foundation provides practical guidance on heart-healthy food choices which support sustainable eating practices. For example, the types of fish we recommend, limiting red meat, using pantry staples which can be stored, cooking from scratch and promoting the safe storage and use of leftovers in our popular recipes.   

• The Heart Foundation is advocating for the inclusion of food sustainability in the next Australian Dietary Guidelines. We look forward to the opportunity to contribute to the Guidelines consultation process to support more Australians to achieve healthy, equitable and sustainable dietary patterns.

• Good planning and design of a community (the built environment) can support healthy eating if healthy food is both available and accessible. For example, we know that healthy food options located within 800 metres from home, school and work increases healthy food uptake. Read more, here.

• We advocate for smokefree legislation to avoid exposing people to secondhand smoke, and to reduce air pollution. This includes banning smoking in city centres and introducing laws to manage smoke drift in housing units. Read more, here.

• The Heart Foundation is a member of the World Heart Federation, which has released an Air Pollution Policy Brief - Clean air, smart cities, healthy hearts. The brief identifies key steps society can take to reduce air pollution. Read more, here.

• Taking a stand against air pollution – the impact on cardiovascular disease. A joint opinion from the World Heart Federation, American College of Cardiology and the European Society of Cardiology (2021)

• Environmental risk factors and cardiovascular disease: a comprehensive expert review (2021)

• 2021 European Society of Cardiology guidelines on cardiovascular disease prevention in clinical practice (2021). These guidelines recommend:

  • Patients at (very) high risk for cardiovascular disease may be encouraged to try to avoid long-term exposure to regions with high air pollution. (Class IIb recommendation, C level of evidence).

  • In regions where people have long-term exposure to high levels of air pollution, (opportunistic) cardiovascular disease risk screening programs may be considered. (Class IIb recommendation, C level of evidence).  

• World Health Organization Compendium of WHO and other UN guidance on health and environment (2021)

• Doctors for the Environment Australia is an organisation of medical professionals that protect human health through care of the environment. Read more, here.

• In Australia, all levels of government play a role in managing Australia’s air quality. States and territories have primary responsibility for monitoring and managing air quality in their jurisdictions. Read more, here.

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